View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-0976	ICR Reference No: 200809-0938-010
Status: Historical Active	Previous ICR Reference No: 200603-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Notice of Denial of Medicare Prescription Drug Coverage
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/24/2008
	Date Received in OIRA: 09/05/2008
Terms of Clearance: This ICR is approved per CMS's 10/15/08 memo and revised form. CMS shall ensure that the Spanish-language version is similarly revised before its issuance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2011	36 Months From Approved	11/30/2008
Responses	290,344	0	1,056,000
Time Burden (Hours)	145,172	0	528,000
Cost Burden (Dollars)	0	0	53,000

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	290,344	1,056,000	-765,656
Annual Time Burden (Hours)	145,172	528,000	-382,828
Annual Cost Burden (Dollars)	0	53,000	-53,000

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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